SUMMARY. The
face, neck and hands are the most frequent parts affected in extensive burn injuries. They
are commonly very deeply burned. Local anatornic particulars have a decisive role in the
management, the resulting deformity and degree of disability. These anatomic facts aic
mainly:

the relative thickness of the skin

the presence of subcutaneous voluntary muscles: the
expression muscles in the face, the platysma in palm

the functional anatomic areas, to be respected
during planning of skin cover and reconstruction.

The present study includes a total of 1578 cases of
fresh bum injuries admitted during a three-year period (Jan. 1985 - Jan. 1988). The neck
was affected in 333 cases (2 1%). In the same period 115 cases suffering from burn neck
contractures were referred to the Plastic Surgery Unit. The pattern of contracture was
classified according to the site, extent and degree. The reconstruction was held long
cnough to allow for softening of the scar. The choice of the operative procedure was
decided according to the pattern, the available skin suitable for transfer and associated
contracture affecting the face, chest wall or axilla. The operative procedures include
Z-plasty with or without skin graft, local cervicoplasty, myocutancous flaps,
fasciocutaneous flaps and free transfer.

The neck and face are the most frequent
areas aflected in extensive burn injuries. The resulting scarring, disfigurement and
disability depend on various factors: the severity and depth of the primary injury and the
success of the applied treatment scheme.
The neck in particular can be affected by the most severe type of flexion contracture.
Some anatomic factors seem to contribute to the pathogenesis of the contracture: the soft
thin skin, the presence of a cutaneous muscle, the platysma, and the ability of the
cervical vertebral column to flex. These factors act more in younger age groups. The role
of the platysma has not been adequately studied. A deep 2nd or 3rd degree burn will force
the platysma into a state of reflex spasm. This and the position of rest will bring the
neck into flexion. The process of healing, deposition of scar tissue and its gradual
maturation by contraction lead to the final position. The scarring will include fibrous
replacement of the destroyed platysma fibres. The pattern of neck scarring, its extent and
degree can be divided into three main groups:

Superficial scarring; localised or extensive

Linear scarring; median or lateral

Cervical obliteration; partial or total.

Some anatomic factors govern the surgical
plan of reconstruction:

The skin cover on the neck extending from the lower border
of the mandible to the suprasternal border and from the anterior border of the trapezius
on either side is 20-25 cm on average (Talaat, 1966).

This extensive surface area is not covered by a homogeneous
sheet of skin. It includes the submandibular area, the central hyold sternal area, and two
lateral areas. The most important of these is the central (h yoid- sterna 1), being most
exposed to sight from the front (Talaat, 1966). This 1 s the area to be considered
most seriously in the choice of skin cover of the best quality available.

The present study 'Includes a total of
1578 cases of fresh burn injuries admitted during a three-year period (Jan. 1985 - Jan.
1988). The neck was affected in 333 cases (21%) (Table 1).
The pattern of contracture was classified according to the site, extent and degree.
The reconstruction was held long enough to allow for softening of the scar. The choice of
the operative procedure was decided according to the pattern, the available skin suitable
for transfer and associated contractures affecting the face, chest wall or axilla.
The operative procedures include: Z-plasty with or without skin graft, local cervicoplasty
(Talaat, 1966); myocutaneous flaps (Abdel-Gharil et al., 1984); fascio-cutancous flaps
(Kadry et al., 1987) and free tissue transfer (Table 2),